Modafinil: Brain booster or brain drain?

Some are using the narcolepsy drug to help them work smarter, but that might not be a good move.

The popularity of modafinil has grown among those seeking increased concentration. (Photo: lassedesignen/Shutterstock)

For Alex Fortin, a 28-year-old Web marketing entrepreneur, productivity is the name of the game. That’s why when “smart drug” modafinil crossed his radar last year, he was immediately intrigued. What if it could help him focus longer, produce better work and bring in more clients?

Fortin did extensive research and decided to order a supply of modafinil online. He was impressed — by the 14-hour workdays he could power through without a break and the “superhuman” levels of concentration, energy and sustained cognition available at the ready. He was also impressed by the lack of significant side effects other than oily skin and an occasional headache. He was so impressed, in fact, that he felt compelled to share his mind-enhancing discovery in a glowing blog testimonial.

“It’s amazing what it does,” Fortin said. “You kind of lose track of time. You’re not hungry. You’re really focused. With modafinil you just want to do whatever you’re working on.”

Stampede for smarts

Modafinil (marketed in the U.S. as Provigil) was approved by the FDA in 1998 for the treatment of narcolepsy, a sleep disorder that causes uncontrollable drowsiness and knockout sleep episodes during the day. Since then, modafinil (pronounced moe-DAF-i-nil) has also been approved to help reduce fatigue in people with obstructive sleep apnea and those with shift-work sleep disorder.

However, in recent years its popularity has skyrocketed among Wall Street entrepreneurs, students and those seeking to raise their cognitive edge in a round-the-clock work world. Particularly attractive is modafinil’s reputation for minimal side effects and lower potential for addiction.

A new study at UC San Francisco found that modafinil prescriptions rose nearly tenfold between 2002 and 2009. Topping the chart were prescriptions for non-FDA-approved uses (including depression and multiple sclerosis), which accounted for 90 percent of the growth. And, remember, that doesn’t factor in the rising number of people, like Fortin, who are flocking online without a prescription to order the drug.

Dr. Tom Scammell, a sleep medicine expert at Beth Israel Deaconess Medical Center in Boston who regularly prescribes modafinil for narcolepsy, notes that researchers don’t know exactly how the drug works. (It appears to enhance dopamine signals in the brain, which may bolster a sense of pleasure and motivation to continue an activity.) But he agrees that modafinil is probably less habit-forming than amphetamine-based ADHD drugs like Ritalin and Adderall.

“There’s not a lot of evidence that people really get a buzz or any pleasurable effects from modafinil,” he said. “So, in that sense, we consider it a somewhat more benign medicine for waking people up than alternative stimulants.”

However, modafinil’s rising use for non-approved reasons worries him.

For one thing, modafinil is not without side effects, which can include insomnia, anxiety, headaches, small rises in blood pressure and in rare cases a severe — and sometimes fatal — allergic reaction.

Also worrisome are those modafinil devotees who’ve noticed a tendency toward antisocial behavior and lack of emotions while under the influence.

Then there’s a new study suggesting that modafinil’s brain-heightening powers may actually be overblown. Research participants who used modafinil while completing a cognitive performance test not only weren’t more accurate than those on a placebo, but they also took longer to finish. That means a lot of people may be taking a potentially risky drug that doesn’t really ramp up brainpower at all.

For Scammell, all this prompts a broader question: Should people without a medical disorder take modafinil to feel more alert and productive, or should they be exploring the possibility that they’re trying to overcome a fatigue-inducing lifestyle?

“There are some big studies showing that on week nights, one-third of all Americans get less than six hours of sleep, which is just not enough,” Scammell said. “My suspicion is that many people who feel they can benefit from modafinil fall into that category. Wouldn’t it be vastly better to schedule your life to get more sleep and feel more cognitively sharp based on a healthier lifestyle rather than taking a medication?”

A personal choice?

Fortin recently cut down on his daily modafinil use after noticing his heart occasionally raced. But he also admits to drinking too much coffee and eating too few healthful meals. Recently he moved from Canada to Ho Chi Minh City, Vietnam, to run his media company away from the cold winters. He’s also cut down on coffee, improved his diet and now saves modafinil for those days when he really needs laser-sharp focus for work.

“I think I was compensating for a bad diet and using modafinil to keep me energized,” he said.

Even so, Fortin is still an ardent advocate for the drug’s mind-expanding properties.

“Modafinil has really had a positive effect on me, and I’ve learned a lot about myself,” he said. “Because I’m able to sit at the computer for hours on modafinil, I now know I can do it without taking anything. Modafinil has also helped me concentrate much more while learning new songs on the guitar. Those skills are skills I still have.

“If anybody wants to be more successful and do more stuff, I’d say try modafinil once to see how it acts on you,” he added. “I think the advantages overcome the negative effects.”